Serum lactate dehydrogenase predicts brain metastasis and survival in limited-stage small cell lung cancer patients treated with thoracic radiotherapy and prophylactic cranial irradiation

Liu, Jianjiang; Wu, Depei; Shen, Bin; Xiao-fang, Zhou; Zhang, Peng; Qiu, Guangle; Ji, Yongling; Du, Xianghui; Yang, Yunjun

doi:10.1007/s00066-022-01977-4

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…ECOG PS was the patient characteristic with the strongest association with survival, providing additional evidence that ECOG PS is an important predictor of survival in patients with lung cancers ( 1 , 34 , 39 ). OS estimates were lower in patients with characteristics traditionally associated with poor prognosis (high LDH, abnormal sodium, and low hemoglobin) ( 35 – 38 , 40 ), confirming the results of our previous analysis in the earlier version of this cohort study ( 34 ). To our knowledge, this is the most current population-based study to comprehensively evaluate treatment patterns and clinical outcomes in Canadian patients with LS-SCLC treated with CT ± RT.…”

Section: Discussionsupporting

confidence: 88%

“…Patient characteristics included current age, age at diagnosis, sex, smoking status, stage of disease at diagnosis, laboratory test results at diagnosis, and ECOG PS at diagnosis. Key parameters of laboratory testing included levels of LDH, sodium, and hemoglobin, which have been identified as important prognostic factors in LS-SCLC ( 35 – 38 ). Laboratory values in our database were acquired prior to cycle 1 and CT typically starts within 1-2 weeks of clinician assessment.…”

Section: Methodsmentioning

confidence: 99%

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Real-world predictors of survival in patients with limited-stage small-cell lung cancer in Manitoba, Canada

Dawe,

Rittberg,

Syed

et al. 2023

Front. Oncol.

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BackgroundAlthough therapy for limited-stage small-cell lung cancer (LS-SCLC) is administered with curative intent, most patients relapse and eventually die of recurrent disease. Chemotherapy (CT) with concurrent radiotherapy (RT) remains the standard of care for LS-SCLC; however, this could evolve in the near future. Therefore, understanding the current prognostic factors associated with survival is essential.ObjectiveThis real-world analysis examines factors associated with long-term survival in patients with LS-SCLC treated with CT in Manitoba, Canada.MethodsA retrospective cohort study was conducted using Manitoba Cancer Registry and CancerCare Manitoba records. Eligible patients were aged >18 years and had cytologically confirmed LS-SCLC diagnosed between January 1, 2004, and December 31, 2018, for which they received CT ± RT. Baseline patient, disease, and treatment characteristics and survival duration, characterized as short (<6 months), medium (6−24 months), and long term (>24 months), were extracted. Overall survival (OS) was estimated at one, two, and five years and assessed using Kaplan-Meier methods and Cox proportional hazards models.ResultsOver the 15-year study period, 304 patients met the eligibility criteria. Long-term survivors comprised 39.1% of the cohort; at diagnosis, this subgroup was younger, more likely to have Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0, and have normal lactate dehydrogenase, sodium, and hemoglobin levels. OS estimates for the entire cohort at one, two, and five years were 66%, 38%, and 18%, respectively. In the ECOG PS 0 subgroup, OS estimates at one, two, and five years were 85%, 52%, and 24%, respectively; OS estimates were 60%, 35%, and 17%, respectively, for ECOG PS 1−2 and were 47%, 23%, and 10%, respectively, for ECOG PS 3−4. OS was significantly higher among patients with normal serum sodium and hemoglobin levels than those with abnormal levels. Univariable hazard regression models found that ECOG PS, age at diagnosis, receipt of prophylactic cranial irradiation (PCI), and thoracic RT were associated with survival. On multivariable hazard regression, ECOG PS and receipt of PCI were associated with survival.ConclusionSurvival for greater than two years in patients with LS-SCLC treated with CT ± RT was associated with ECOG PS and receipt of PCI.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Real-world predictors of survival in patients with limited-stage small-cell lung cancer in Manitoba, Canada

Dawe,

Rittberg,

Syed

et al. 2023

Front. Oncol.

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“…At present, there are many risk factors for BM of SCLC reported worldwide, such as LDH, 14 CEA, 15 gastrin releasing peptide precursor (ProGRP) 16 and PLT, 17,18 HGB 18 , neutrophil to lymphocyte ratio (NLR), [19][20][21] monocyte-lymphocyte ratio (MLR), 21 prognosticnutrition index (PNI), 21 TNM stages, 15,16,18,19,[22][23][24][25][26][27] lymphovascular invasion or not, 23 radical surgery or not, 22 concurrent chemotherapy (CCRT) or not, 21 response to chemotherapy, 28 weight loss, 28 time to thoracic radiotherapy, 16,19 chemotherapy cycles, 16,19 dose of thoracic radiotherapy, 29 size of primary tumour, 25 segmentation method of thoracic radiotherapy, 26 age, 27 gender, 18,27 and so forth. However, only three of these studies established a predictive model for BM in SCLC; it is expected that prediction models for these factors of high risk of BM can be subsequently established and verified both internally and externally.…”

Section: Discussionmentioning

confidence: 99%

Construction of brain metastasis prediction model in limited stage small cell lung cancer patients without prophylactic cranial irradiation

Guo,

Liu,

et al. 2024

Clinical Respiratory J

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IntroductionSmall cell lung cancer (SCLC) is a highly aggressive lung cancer variant known for its elevated risk of brain metastases (BM). While earlier meta‐analyses supported the use of prophylactic cranial irradiation (PCI) to reduce BM incidence and enhance overall survival, modern MRI capabilities raise questions about PCI's universal benefit for limited‐stage SCLC (LS‐SCLC) patients. As a response, we have created a predictive model for BM, aiming to identify low‐risk individuals who may not require PCI.MethodsA total of 194 LS‐SCLC patients without PCI treated between 2009 and 2021 were included. We conducted both univariate and multivariate analyses to pinpoint the factors associated with the development of BM. A nomogram for predicting the 2‐ and 3‐year probabilities of BM was then constructed.ResultsUnivariate and multivariate analyses revealed several significant independent risk factors for the development of BM. These factors include TNM stage, the number of chemotherapy (ChT) cycles, Ki‐67 expression level, pretreatment serum lactate dehydrogenase (LDH) levels, and haemoglobin (HGB) levels. These findings underscore their respective roles as independent predictors of BM. Based on the results of the final multivariable analysis, a nomogram model was created. In the training cohort, the nomogram yielded an area under the receiver operating characteristic curve (AUC) of 0.870 at 2 years and 0.828 at 3 years. In the validation cohort, the AUC values were 0.897 at 2 years and 0.789 at 3 years. The calibration curve demonstrated good agreement between the predicted and observed probabilities of BM.ConclusionsA novel nomogram has been developed to forecast the likelihood of BM in patients diagnosed with LS‐SCLC. This tool holds the potential to assist healthcare professionals in formulating more informed and tailored treatment plans.

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“…According to the current guidelines, concurrent platinum-based radiochemotherapy (RCT) with subsequent prophylactic whole-brain irradiation (WBI) is regarded as standard treatment for SCLC patients with limited disease [ 8 , 9 ]. At this stage of disease, a recent study has shown that in patients treated with thoracic RT and WBI, intratherapeutic maximal serum lactate dehydrogenase levels are predictive of possible brain metastasis and survival [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Reduction of tumor volume during radiotherapy in patients with small-cell lung cancer and its prognostic significance

Kandler,

Elsayad,

Evers

et al. 2023

Strahlenther Onkol

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Background Several studies have reported the potential prognostic significance of tumor volume reduction ratio (VRR) induced by radiotherapy (RT) in patients with non-small-cell lung cancer. However, there are no data yet on the prognostic significance of volumetric shrinkage in patients with small-cell lung cancer (SCLC). This study aimed to demonstrate the correlation between tumor volume reduction ratio and treatment outcomes. Materials and methods The study included 61 patients with SCLC treated with fractionated RT of the primary tumor at our institution between 2013 and 2020. The relationship between volumetric changes in gross tumor volume (GTV) during radiotherapy and outcomes were analyzed and reported. Results The median radiation dose was 59.4 Gy (median fraction dose was 1.8 Gy). The median GTV before radiotherapy was 74 cm3, with a median GTV reduction of 48%. There was a higher VRR in patients receiving concurrent radiochemotherapy (p = 0.05). No volumetric parameters were identified as relevant predictors of outcome in the entire cohort. In multivariate analysis, only age had an impact on survival, while prophylactic whole-brain radiation influenced the progression-free survival significantly. Conclusion Concurrent chemotherapy was associated with a higher VRR than sequential chemotherapy. No significant impact of VRR on patients’ outcome or survival was detected.

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Serum lactate dehydrogenase predicts brain metastasis and survival in limited-stage small cell lung cancer patients treated with thoracic radiotherapy and prophylactic cranial irradiation

Cited by 6 publications

References 31 publications

Real-world predictors of survival in patients with limited-stage small-cell lung cancer in Manitoba, Canada

Real-world predictors of survival in patients with limited-stage small-cell lung cancer in Manitoba, Canada

Construction of brain metastasis prediction model in limited stage small cell lung cancer patients without prophylactic cranial irradiation

Reduction of tumor volume during radiotherapy in patients with small-cell lung cancer and its prognostic significance

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